When neurologists diagnose functional neurological disorder, why don’t they code for it?

Abstract

Background Clinicians who recognize functional neurological disorders (FND) may not share that diagnosis with patients. Poor communication delays treatment and contributes to substantial disability in FND. Diagnostic (ICD-10) coding, one form of medical communication, offers an insight into clinicians’ face-to-face communication. Therefore, quantifying the phenomenon of noncoding, and identifying beliefs and practice habits that reduce coding, may suggest routes to improve medical communication in FND. Methods We reviewed all pediatric neurology consultations in our hospital from 2017 to 2020, selecting those in which neurologists explicitly stated an FND-related diagnosis (N = 57). We identified the neurological symptoms and ICD-10 codes assigned for each consultation. In parallel, we reviewed all encounters that utilized FND-related codes to determine whether insurers paid for this care. Finally, we assessed beliefs and practices that influence FND-related coding through a nationwide survey of pediatric neurologists (N = 460). Results After diagnosing FND, neurologists selected FND-related ICD-10 codes in only 22.8% of consultations. 96.2% of neurologists estimated that they would code for non-epileptic seizure when substantiated by electroencephalography; in practice, they coded for 36.7% of such consultations. For other FND manifestations, neurologists coded in only 13.3% of cases. When presented with FND and non-FND scenarios with equal levels of information, neurologists coded for FND 41% less often. The strongest predictor of noncoding was the outdated belief that FND is a diagnosis of exclusion. Coding for FND never resulted in insurance nonpayment. Conclusion Noncoding for FND is common. Most factors that amplify noncoding also hinder face-to-face communication. Research based on ICD-10 coding (eg, prevalence and cost) may underestimate the impact of FND by >fourfold.

HypermobileEhlers‐DanlosSyndrome: A Prodromal Subtype of Functional Movement Disorders?

“…The number of FMD patients may be underestimated overall and within the EDS patient sample. It has been reported that after making a diagnosis of FND only 22.8% of neurologists code for FND after the consultation 25 . There is also the chance of misdiagnosis of functional versus other movement disorder, which could have skewed our data.…”

“…It has been reported that after making a diagnosis of FND only 22.8% of neurologists code for FND after the consultation. 25 There is also the chance of misdiagnosis of functional versus other movement disorder, which could have skewed our data. The rate of misdiagnosis of FMD is reportedly low, occurring in 4% of 1466 patients included in a meta-analysis of 27 studies.…”

Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder

“…All these clinicians and their teams have contributed to recent advances in theory, best-practice guidelines, and evaluation of treatment outcomes, thereby providing direction for clinicians around the world (see Supplemental Text Box 2, http://links.lww.com/HRP/A210). 10,11,15,20,25,37,40,43,58,59,74,80,81,92,108–128 Through collaborative efforts, these teams have also worked hard to highlight that the pressing need to develop an FND-informed culture of care that takes into account recent advances in our understanding and clinical care of children and adolescents with FND 26 …”

How Is Functional Neurological Disorder Managed in Australian Hospitals? A Multi‐Site Study Conducted on Acute Inpatient and Inpatient Rehabilitation Wards

“…Reduced communication of FND through medical record documentation may be linked to the ongoing confusion or reduced confidence about defining and diagnosing FND. Other potential drivers reported in the literature include doctors still incorrectly treating FND as a diagnosis of exclusion, 30 continuing to fear misdiagnosis, 12 and holding FND to a higher diagnostic threshold than other neurological disorders 31 . There are ethical implications of withholding a diagnosis and limitations to capturing the required services to manage FND.…”

“…The key steps in developing these specialized services are improving education of health care professionals and developing targeted clinical pathways 32,37 . These may lead to improved access to coordinated multidisciplinary management and likely subsequently reduce stigma and disability through improving patient outcomes 31,32,37 …”